Ovarian cancer in women with prior hysterectomy: a 14-year experience at the University of Miami

Article Abstract:

Ovarian cancer is the fifth leading cause of cancer death in women, and the most common cause of death from gynecologic cancer. One of every 70 female newborns will develop ovarian cancer during her life. Since most newly diagnosed cases are in advanced stages, the 5-year survival rate for ovarian cancer is less than 20 percent. Early detection can be accomplished by ultrasound, routine pelvic examination, and measurement of tumor markers in the blood; further studies are needed to evaluate the effectiveness of these measures in large groups. One preventive method is the removal of the ovaries (oophorectomy) of women known to be at high risk for the disease for familial reasons. To evaluate the effect of oophorectomy in women who have undergone hysterectomy only (removal of the uterus), the medical records of 95 patients were reviewed. These women developed ovarian cancer after hysterectomy and represented a subset of 755 patients at one medical center who underwent treatment for ovarian cancer during a 14-year period. The hysterectomies on the 95 women had been performed abdominally (61 cases) or vaginally (30 cases); in 4 cases, the route was unknown. One ovary was removed during abdominal hysterectomy in 25 patients; both ovaries were left intact in all patients who had vaginal hysterectomy, except one. Sixty women whose ovaries had been conserved were more than 40 years old when they underwent hysterectomy. Ovarian cancer was diagnosed, on average, 17.2 years after hysterectomy, but the range was 13 months to 49 years. Almost 72 percent of these patients were diagnosed when ovarian cancer had reached stage III or IV. Survival rates of this group were similar to those of all patients with ovarian cancer: Stage I, 50 percent; stage II, 43 percent; stage III, 16 percent; and stage IV, 7 percent. If prophylactic oophorectomy had been performed in the women 40 years of age and older, 60 cases of ovarian cancer treated at this medical facility would have been prevented. It is estimated that 810,000 hysterectomies will be performed in the US in 1995. Women who undergo vaginal hysterectomy make up 28 percent of hysterectomy patients, but fewer than 2 percent of these women undergo oophorectomy. A policy of prophylactic oophorectomy is recommended for all women older than 40 who undergo hysterectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Development and progression, Surgery, Ovariectomy

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Characterization of in vitro chemosensitivity of perioperative human ovarian malignancies by adenosine triphosphate chemosensitivity assay

Article Abstract:

Information about the sensitivity of cancer cells to chemotherapy (chemosensitivity) would help in planning an effective regimen for treating cancer patients. Various tests have been developed to assess chemosensitivity, such as the adenosine triphosphate (ATP) chemosensitivity assay. ATP is a molecule that is capable of storing large amounts of cell energy, which is used to drive cell reactions. The ATP content provides a good measure of the number of viable cells, which can be determined using the luciferin-luciferase assay, a biochemical test. In the ATP chemosensitivity assay, the ATP content is determined in tumor cells treated with specific anticancer agents, and compared with that of untreated tumor cells. A decrease in the ATP content of the treated tumor cells relative to the untreated cells would suggest sensitive to the specific anticancer agents. The effectiveness of the ATP chemosensitivity assay was assessed in samples of primary and recurrent human ovarian tumor cells. Primary cells are those obtained following the initial diagnosis of ovarian cancer, whereas the recurrent cells are from the episodes of ovarian cancer after the initial diagnosis. Sensitivity to chemotherapy was defined as a 70 or more percent decrease in ATP content of treated cells relative to that of untreated cells. Cell viability was shown to decrease with increasing doses of anticancer agents. Of 13 primary tumors, 15.4 percent were sensitive to cisplatin, 7.7 percent to 4-hydroxycyclophosphamide, and 53.8 percent to combined use of these agents. Of seven recurrent tumors, 14.3 percent were sensitive to cisplatin, 28.6 percent to 5-fluorouracil, and 42.9 percent to the combination of these agents. The sensitivity to chemotherapeutic agents was consistent with results of previous studies evaluating patient response. These findings suggest that the ATP chemosensitivity assay is an effective and reliable method for testing chemosensitivity of human tumors to anticancer agents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Adenosine triphosphate, ATP, Chemotherapy, Biological assay, Bioassay

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Comparative efficacy of short-term versus long-term cefoxitin prophylaxis against postoperative infection after radical hysterectomy: a prospective study

Article Abstract:

The antibiotic cefoxitin has been shown to be effective in preventing infection after surgery. Although antibiotics are effective in preventing infection following hysterectomy (surgical removal of the uterus), the optimal duration of antibiotic treatment has not been established. Antibiotics may persist at the surgical wound and thereby prevent infection after surgery. Alternatively, antimicrobial agents may sufficiently eliminate infective organisms during surgery and hence may not be needed in the period following surgery. The effectiveness of a short-term regimen of three doses of cefoxitin was compared to that of a long-term regimen of 12 doses of cefoxitin in preventing infection following hysterectomy. The short-term regimen was given to 54 patients and the long-term regimen to 59 patients. All patients had similar demographic profiles, risk factors, and clinical courses. The incidences of infections developing at surgical wounds, urinary tract infections, and fever-associated illness were similar for all patients. These findings suggest that a short-term regimen of three doses of cefoxitin is as effective as a long-term regimen of 12 doses of cefoxitin in preventing infection following hysterectomy. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgical wound infections, Dose-response relationship (Biochemistry), Dose-response relationship, Cefoxitin

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